{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T21:55:44Z","timestamp":1792533344096,"version":"4.5.0"},"reference-count":23,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Digestive Endoscopy"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aim<\/jats:title>\n                    <jats:p>We present the first experience with the submucosal injection\u2010guided septotomy (SING) technique, which integrates the principles of flexible endoscopic septotomy with submucosal endoscopy, applied in different phases of the procedure for the treatment of Zenker's diverticulum (ZD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Prospectively collected data from consecutive ZD patients treated with SING at three Italian centers (October 2019\u2013August 2024) were analyzed. The primary outcome was clinical success (CS; Kothari\u2010Haber Score &lt;\u20092 at 3\u2009months), whereas secondary outcomes included technical success (TS), procedural time, adverse events (AEs), hospital stay, and time to recurrence (Kaplan\u2013Meier method). We also performed subgroup analysis according to ZD dimension (large vs. small) and to soft diverticuloscope use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 102 patients underwent SING (median age 74\u2009years [IQR 68\u201381]; 69.7% male). Median diverticulum depth was 30\u2009mm (IQR 25\u201340) and baseline KHS score 4 (IQR 3\u20136). CS was achieved in 98% (95% CI 93.6%\u201399.8%), with 7% (95% CI 2.9%\u201313.9%) experiencing symptom recurrence over a median follow\u2010up of 370\u2009days (IQR 297\u2013747). Recurrence\u2010free probabilities were 93.5% at 6\u2009months, 92.0% at 12\u2009months, and 92.0% at 24\u2009months. TS was 100%, median procedural time 30\u2009min (IQR 25\u201345), and AEs occurred in 3 patients (2.9%), all managed endoscopically.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>SING is a safe and effective endoscopic treatment for ZD. Prospective comparative studies with standard techniques are warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/den.70156","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T06:00:22Z","timestamp":1777528822000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Submucosal Injection\u2010Guided Septotomy (\n                    <scp>SING<\/scp>\n                    ) for the Treatment of Zenker's Diverticulum: A Multicenter Study of Over 100 Procedures (With Video)"],"prefix":"10.1111","volume":"38","author":[{"given":"Francesco","family":"Azzolini","sequence":"first","affiliation":[{"name":"Gastroenterology and Gastrointestinal Endoscopy Unit, IRCCS San Raffaele Hospital  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9395-5468","authenticated-orcid":false,"given":"Giuseppe","family":"Dell'Anna","sequence":"additional","affiliation":[{"name":"Gastroenterology and Gastrointestinal Endoscopy Unit, IRCCS San Raffaele Hospital  Milan Italy"},{"name":"Gastroenterology and Gastrointestinal Endoscopy Unit, IRCCS Policlinico San Donato  Milan Italy"},{"name":"Unit\u00e9 D'endoscopie Interventionnelle, H\u00f4pital Priv\u00e9 Des Peupliers, Ramsay G\u00e9n\u00e9rale de Sant\u00e9  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurizio","family":"Spandre","sequence":"additional","affiliation":[{"name":"Digestive Endoscopy Unit, Division of Gastroenterology Ospedale San Giovanni Bosco, ASL Citt\u00e0 di Torino  Turin Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Pugliese","sequence":"additional","affiliation":[{"name":"Department of Digestive and Interventional Endoscopy Niguarda Hospital, ASST Niguarda  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0179-8929","authenticated-orcid":false,"given":"Alberto","family":"Barchi","sequence":"additional","affiliation":[{"name":"Gastroenterology and Gastrointestinal Endoscopy Unit, IRCCS San Raffaele Hospital  Milan Italy"},{"name":"Faculty of Medicine and Surgery, Vita\u2010Salute San Raffaele University  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-3967-2684","authenticated-orcid":false,"given":"Ernesto","family":"Fasulo","sequence":"additional","affiliation":[{"name":"Gastroenterology and Gastrointestinal Endoscopy Unit, IRCCS San Raffaele Hospital  Milan Italy"},{"name":"Faculty of Medicine and Surgery, Vita\u2010Salute San Raffaele University  Milan 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